1103 - Complications of “very high” leukocytosis in pediatric acute leukemia patients managed without rasburicase and leucopheresis

Date 28 September 2012
Event ESMO Congress 2012
Session Publication Only
Topics Leukaemia
Supportive and Palliative Care
Presenter Rajkumar Singh
Authors R.B. Singh, K. Munot, S. Pathania, S. Bakhshi
  • Dept. Of Medical Oncology, All India Institute of Medical Sciences (AIIMS) Institute Rotary Cancer Hospital, 110029 - New Delhi/IN



Hyperleukocytosis in pediatric leukemias is associated with acute complications of tumor lysis syndrome (TLS) and leucostasis. In developing countries, rasburicase is not available and even if available, it may not be affordable by all patients. Rasburicase became freely available in India in 2010. We evaluated acute complications pertaining to hyperleukocytosis in pediatric acute leukemia patients prior to free availability of rasburicase, and without leucopheresis.


Records of pediatric acute leukemia patients and “very high” leucocytosis (VHL) (WBC > 100,000/mm3 in AML and > 200,000/mm3 in ALL) were analyzed. None of these patients received rasburicase and /or leucopheresis. Patients were managed with allopurinol and aggressive hydration. Data was analyzed for baseline presentation, TLS and other complications pertaining to leucostasis.


Out of 457 pediatric acute leukemia patients from Jun 2003-Dec 2009, there were 45 (10%) patients with VHL. Median age was 10 years (SD-4.4; range 3-18) and male: female ratio was 6.5:1. B-ALL, T-ALL and AML constituted 11 (24.4%), 16 (35.5%) and 18 (39.9%) patients respectively. Mean baseline WBC for ALL and AML patients was 296,500/mm3 (SD- 104,793; range 200,000-615,220) and 206,300/mm3 (SD- 110,000; range 106,100-541,900) respectively. Laboratory TLS was seen in 17 (37.7%) patients [ 2 (4.4%) at baseline while 15 (33.3%) patients developed it after chemotherapy initiation]. Clinical TLS was observed in 6 (13.3%) and renal dysfunction in 7 (15.5%) patients; none required dialysis. CR was achieved in 32 (71.1%) pts and there were 3 (6.6%) deaths. No relation was seen between laboratory TLS and baseline features or mortality. Thrombocytopenia below median (<31,000/mm3) was associated with mortality (p = 0.03); hypolabuminia <3.5g/Dl was associated with hypocalcemia (p = 0.004) and kidney dysfunction (p = 0.04).


Although TLS is common in this “very high” risk group of pediatric leukemias, yet a good outcome with respect to acute complications is possible with proper hydration and allopurinol without rasburicase and leucopheresis. VHL with thrombocytopenia is a risk factor for mortality.


All authors have declared no conflicts of interest.